Maryland Licensed Clinical Appeals RN

A company is looking for a Clinical Appeals RN to work on post-service appeals for Medicare-based claims remotely.

Key Responsibilities :

Review provider post-service appeals for Medicare and Retirement

Gather clinical information, including medical records and coverage criteria, as per Medicare guidelines

Discuss cases with medical directors and collaborate with other teams to process cases

Required Qualifications :

Undergraduate degree or equivalent experience

Unrestricted, active RN license

2+ years of RN experience in an acute setting

Proven working knowledge of Clinical Criteria and CMS Guidelines / InterQual

Demonstrated ability to have high-speed internet installed in a HIPAA-compliant home workspace